Tuesday, April 10, 2012

Obesity causes diabetes


Frequency 

The prevalence of type 2 diabetes is closely associated with the development of obesity. An epidemic of obesity that is present throughout the world especially in highly industrialized countries and developing countries is one of the most important factors for diabetes. According to estimates in the world today more than 170 million people suffer from diabetes, and 2025. That number will more than double. Mean incidence of diabetes is 2-5%, the lowest in rural areas of China (under 1%) and highest among the Pima Indians of North America (50%). The incidence of diabetes in our country does not have reliable data, but it is assumed that it is about 3%, with the largest in. About 90% of all cases of diabetes are diagnosed with type 2 diabetes
The increase in the incidence of diabetes has the greatest impact of "modern, Western" way of life, which is characterized by an increased intake of calories and fat in the diet, obesity, sedentary lifestyle (physical inactivity), "stressful life" bad habits (smoking), etc.. Diabetes affects. Different incidence of diabetes between the sexes is being explained by different levels of physical activity and dietary habits between the sexes. On the occurrence of this form of diabetes and plays an important role genetic or racial predisposition (Pima Indians).
The incidence of diabetes was highest in the period of 65-74. year.

The cause of

Reduced insulin sensitivity is present in most patients with type 2 diabetes independent of body weight and is associated with several factors: genetics (yet undefined), which over time (age) has risen in importance, sedeternim lifestyle, abdominal visceral obesity, etc. . There are two main groups of patients with type 2 diabetes: obesity and type 2 diabetes negojazni.

Obese type 2 diabetes. The prevalence of obesity varies among different races, continents, cultures, level of economic development. About 70% of people in the U.S. and Europe with newly diagnosed diabetes are obese, while the number in China and Japan, half the size. These patients showed reduced sensitivity to insulin action as kolerila particularly with abdominal obesity. Distended adipocytes, liver and muscle cells of these individuals are resistant to the additional storage of glycogen and triglycerides in their depots. Often the presence of beta cell hyperplasia is present so that normal or increased insulin response to glucose in the early stages of the disease.Later, leading to decreased secretion of beta cells. The main cause of insulin resistance in target tissues of obese people is postreceptor defect in insulin effects. As a result of hyperinsulinism occurs which further deepens the resistance "down" regulation of insulin receptors. When an hyperglycemia specific glucose transporter - protein also contributes to resistance.

Insulin resistance syndrome (metabolic syndrome, syndrome X). When in type 2 diabetes, insulin resistance occurs is considered that diabetes is only one part of the metabolic syndrome. His association with hyperglycemia, hyperinsulinemia, dyslipidemia, and hypertension leads to coronary heart disease and stroke.Disruptive effect of insulin leads to hyperglycemia, which causes hyperinsulinemia. Hyperinsulinemia can correct hyperglycemia and tp 2 diabetes becomes manifest. A large amount of insulin increases the retention of the renal tubules leading to hypertension. It increases the production of VLDL in the liver, leading to hypertriglyceridemia and consequently a decrease in HDL cholesterol, which is also associated with hyperinsulinemia. High levels of insulin can stimulate endothelial cell proliferation and vascular smooth muscle - the effect of the hormone receptors of growth factors - causing atherosclerosis. Thrombi in atheromathosis courts represent a higher risk of insulin resistance syndrome because it is already present in association with increased PAI-1 (plasminogen activator inhibitor 1), circulating factor which is produced by adipocytes and visceral omental tissue that inhibits the breakdown of fat. These processes have proven to present but the exact mechanism of their interactions is still a subject of speculation.

Negojazni type 2 diabetes. About 30% of type 2 diabetes is negojazno, although their percentage varies according to the previously mentioned factors. In these patients, a larger problem is the reduced insulin secretion, but also can identify and insulin resistance in the postreceptor level.
The development of biotechnology different genetic abnormalities were found in this subgroup of diabetic patients.


Risk Factors

Risk factors for type 2 diabetes
First Family history of type 2 diabetes (parent, one twin)
Second Obesity (≥ 20% of desirable body weight or BMI ³ 27 kg/m2)
Third Age ³ 45 years
4th Previously identified glucose intolerance syndrome (IGT) or the syndrome of loss of normal fasting glucose (IFG)
5th The data on gestational diabetes, or data that the woman had a baby weighing more than 4 kg
6th Hypertension (³ 140/90 mmHg)
7th HDL cholesterol £ 0.9 mmol / L and / or triglycerides ³ 2.8 mmol / l
8th Polycystic ovaries (PCO syndrome)


Symptoms

The classic symptoms such as polyuria, thirst, blurred vision, paresthesias, and weakness are the manifestations of hyperglycemia and hypoosmotic diuresis and are present in both types of diabetes, even in type 2 diabetes, but little in the beginning of the disease. Most patients with type 2 diabetes is insidious beginning Blest, who can be asymmetric for years, especially in obese patients where the disease is usually discovered by chance an opportunity routine analysis or in the course of action detection of diabetes. Chronic infections of the skin, mouth, generalized pruritus, fungal vulvovaginitis in women and balanitis in men may indicate the presence of diabetes. Negojazni patients with mild form of diabetes have a characteristic physical findings at the time of detection of diabetes. Obese diabetics have razlińćute types of obesity, but it is proven that obesity is particularly associated with central obesity ("visceral, male, android obesity, apple-shaped") with increased waist circumference (> 88cm Uzen and> 102cm in men), with obesity and the rest of the upper body (chest, neck, face), in contrast to ginekoidnog gjaznosti type ("female type, pear, centrifugal type). Besides the association with diabetes, possibly through insulin resistance, central obesity is associated with hypertension, coronary heart disease and dislpidemijom.

Prevention

Type 2 diabetes has a strong familial basis and at least 40% of the relatives of the patient with type 2 diabetes will get the disease during their lifetime. Twin patient almost certainly (90%). Getting diabetes. However, exact identification number and location of the gene has not yet been determined, although it is certainly not exactly the same in different populations. Identification would allow implementation of intense preventive measures to modify environmental factors in individuals at risk for type 2 diabetes. Dijabetogenih list of factors is increasing.Obesity, lack of physical activity, age, and so. "Modern" way of life, remain the most important factors. There is talk of "Coca Colo (zation)," some companies, and diabetes is called "western killer" Studies have clearly shown that the transition to "modern, Western" lifestyle (sedaternost, diet with lots of calories, sugar and fat saturisanih), predisposes the development of disorders glucose metabolism and diabetes. Approximately 75-80% of patients with type 2 diabetes has been, or are obese. Number of people with overweight and obesity is increasing. The best measure of weight (mass), the body mass index (BMI), which represents the ratio of weight (kg) and height squared (m2). Normal weight mean IMT of 20-25, 26-30 increased BMI and obesity BMI> 30 kg/m2. Since 1991, the number of obese Americans has increased by nearly 60%. About 31% of men and 35% of women are obese. Obesity among black women, and reaches up to 50%. The total amount of body fat and its distribution are important. The central (or abdominal) obesity is an independent risk factor. It seems that general obesity affects insulin secretion and resistance in the abdominal. Intraabdominal adipose tissue shows a high degree of lipolysis, resulting in increased portal and peripheral levels of free fatty acids, and leads to hepatic and muscle resistance. Diet with lots of fat, a little complex carbohydrates and little dietary fiber predisposes obesity and / or diabetes. The highest incidence of people with overweight. in the age group of 50-70 years, with 52% women and 42% of men. In the age group of 29-70 years, 34% were overweight, and about 20% of teenagers have a weight above normal. Ironically, in the U.S. over 58 people were well pleased with excess weight, which is almost identical to the number of Americans who daily eat in one of 160,000 fast-food restaurants in the United States.Prevention of medication. In several studies have examined, and examined the effect of a | protected drugs in the prevention of type 2 diabetes The goal is to increase insulin sensitivity by reducing insulin resistance. Earlier tests sulfonylurea, acarbose, and other so far not given the expected results. Latest The results of application of certain medications have shown a preventive effect of metformin and orlistat. The role of metformin in preventing type 2 diabetes mellitus examined her DPP study. People in metforminskoj group were treated with metformin 850 mg twice a day, while the control received the placebo, while both were on a standard diet and physical activity.Metformin therapy reduced the risk of developing diabetes by 31% (29vs22%). Metformin was effective in both men and women, but much smaller effect is achieved by the elderly and those with less excess weight. The exact mechanism of action of metformin on insulin reziztenciju not fully known, but the latest surveyed pointed to the possible effect of insulin reducing activity of plasma cell antigen PC-1, which is elevated in people with insulin resistance. DPP study was provided | eno and testing troglitazona (booster effect of insulin), but the treatment is interrupted troglitazonom 1998 because of possible liver toxicity. On the potential role of ACE-inhibitor ramipril was pointed out in the HOPE study. During follow-up of 4.5 years from 2837 patients in the ramipril 3.6% developed diabetes, whereas in the placebo group (2883) this number was higher and amounted to 5.4%. This hypothesis requires further investigation.

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